Gut Microflora Associated Characteristics in Children with Celiac Disease

Editor’s note: This important study demonstrated that short chain fatty acid (SCFA) levels in stool samples were abnormal in participating children with celiac disease, with and without treatment with gluten-free diet. SCFAs are healthy energy byproducts produced by microflora (beneficial organisms) in the colon during fermentation of undigested carbohydrates arriving from the small intestine. SCFAs nourish the colonocytes, cells that line the colon, to maintain normal function. They also help absorb salts and water from stool.

“Gut Microflora Associated Characteristics in Children with Celiac Disease”

Background and aim: The aim of the study was to investigate the metabolic function of intestinal microflora in children with celiac disease in order to find out if there is a deviant gut flora in celiac disease patients compared to healthy controls.

Methods: The study group comprised children with celiac disease, consecutively diagnosed according to current criteria given by the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition. Thirty-six children were studied at presentation, i.e., on a normal gluten-containing diet, with clinical symptoms and signs indicative of celiac disease, positive celiac serology markers, and a small bowel biopsy showing severe enteropathy. Forty-seven patients were studied when they had been on a gluten-free diet for at least 3 months. For comparison, a group of 42 healthy controls were studied. The functional status of the intestinal microflora was evaluated by gas-liquid chromatography of short chain fatty acids in fecal samples.

Results: There was a significant difference between untreated celiac disease children and healthy controls as well as between treated celiac disease children and healthy controls regarding acetic, i-butyric, i-valeric acid, and total SCFAs. The propionic and n-valeric acids differed significantly between celiac disease children on gluten-free diet and healthy controls. Moreover, there was a strong correlation between i-butyric and i-valeric acids in all study groups.

Conclusions: This is the first study of the SCFA pattern in fecal samples from children with celiac disease. The results indicate that there is a difference in the metabolic activity of intestinal microbial flora in children with celiac disease compared to that in healthy controls. The finding of a different pattern of some SCFAs in celiacs both at presentation and during treatment with gluten-free diet indicates that it is a genuine phenomenon of celiac disease not affected by either the diet, the inflammation, or the autoimmune status of the patient.